Periodontal disease and atherosclerotic vascular disease: Does the evidence support an independent association?: A scientific statement from the American heart association

A link between oral health and cardiovascular disease has been proposed for more than a century. Recently, concern about possible links between periodontal disease (PD) and atherosclerotic vascular disease (ASVD) has intensified and is driving an active field of investigation into possible association and causality. The 2 disorders share several common risk factors, including cigarette smoking, age, and diabetes mellitus. Patients and providers are increasingly presented with claims that PD treatment strategies offer ASVD protection; these claims are often endorsed by professional and industrial stakeholders. The focus of this review is to assess whether available data support an independent association between ASVD and PD and whether PD treatment might modify ASVD risks or outcomes. It also presents mechanistic details of both PD and ASVD relevant to this topic. The correlation of PD with ASVD outcomes and surrogate markers is discussed, as well as the correlation of response to PD therapy with ASVD event rates. Methodological issues that complicate studies of this association are outlined, with an emphasis on the terms and metrics that would be applicable in future studies. Observational studies to date support an association between PD and ASVD independent of known confounders. They do not, however, support a causative relationship. Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes

Benefits of exercise therapy in peripheral arterial disease

Peripheral arterial disease (PAD) is a common disorder caused largely by atherosclerosis. Although it is associated with increased morbidity and cardiovascular mortality, PAD remains underdiagnosed. Traditional PAD care has involved cardiovascular risk factor modification, use of antiplatelet agents, and revascularization. For those individuals who are eligible and willing to perform exercise therapy (ET), a significant benefit may be recognized. Despite this, ET faces several challenges to implementation. Notably, the lack of reimbursement by third party payers remains the major challenge to routine use of ET